Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Z Year3 Clinical Presentations > Acute Joint Pain > Flashcards

Acute Joint Pain Flashcards

1
Q

What diagnosis must you exclude with joint pain?

A

septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is septic arthritis dangerous?

A
  1. destroy articular cartilage in days

2. mortality of 10% due to bacteriaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can joint pain be due to?

A

pathology in the joint or from structures outside the joint (ie.e not true arthritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some articular causes of single acutely painful joint (monoarthritis)?

A
  1. Trauma (resulting in e.g. fracture, mensical tear)
  2. Gout
  3. Psuedogout
  4. Septic arthitis
  5. Seronegative spondyloarthropathy
  6. Transient synovitis
  7. First presentation of chronic mono/polyarthritis (e.g. osteo, rheum)
  8. Haemarthrosis
  9. Sarcoidosis
  10. Amyloidosis
  11. Vasculitis
  12. SLE
  13. Rheumatic fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the peri-articular pathologies causing pain around a joint?

A
  1. Ligament injury
  2. Tendinitis
  3. Bursitis
  4. Fasciitis
  5. Epicondylitis
  6. Periostitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the

non-articular pathologies causing pain around a joint?

A
  1. nerve entrapment
  2. radiculopathy
  3. bone malignanacy
  4. vasculopathy
  5. osteomyelitis
  6. neuroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What questions should you ask in the history to narrow down the differential?

A
  1. Pain: socrates
  2. trauma
  3. RF for gout
  4. RF for septic arthritis
  5. RF for haemarthrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What could be the cause of acute joint pain that worsens with movement but better on rest?

A

non-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What could be the cause of acute joint pain that has an acute onset (hours)?

A
  1. septic arthritis
  2. gout
  3. pseudogout
  4. trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What could be the cause of acute joint pain with an insidious onset?

A
  1. bursitis

2. tendonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What could be the cause of acute joint pain with a chronic onset?

A

oesteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should you ask a patient to asses acute joint pain?

A

can the patient weight bear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do you ask about trauma?

A

can precipitate infection or gout (so trauma does not exclude other things)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are RF for gout?

A
  1. use of thiazide diuretics
  2. recent heavy alcohol intake
  3. chronic renal failure
  4. chemotherapy
  5. history of renal stones
  6. previous episodes of gout
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the RF for septic arthritis?

A
  1. immunosuppresion (e..g diabetes, HIV, steroid use)

2. prosthetic joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are RF for haemarthrosis?

A
  1. due to coagulopathy (e.g. haemophilia)
  2. anticoagulant use (warfarin)
  3. trauma (e.g. ruptured anterior cruciate ligament in knee)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What PMHx should you ask about with acute joint pain?

A
  1. Recent GI or urethral infection?
  2. Previous episodes?
  3. Rheuamtological disease?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What pathology could be suggested if several joints sequentially affected?

A
  1. gonococcus

2. rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What pathology could be suggested if several joints sequentially simultaenously?

A

first presentation of a chronic polyarthritis (e.g. rheumatoid or psoriatic arthritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why should you ask about sexual history?

A

gonococcal infection can lead to septic arthirtis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do you ask about recent GI or urethral infection?

A

reactive arthritis can develop after these

22
Q

What previous episodes do you ask about?

A

recurrent conditions e.g. crystal arthropathies and overuse injuries

23
Q

Which drugs should you ask about and predipose to gout?

A
  1. thiazides
  2. low dose aspirin
  3. ciclosporin
24
Q

Which drugs can predispose to osteoporosis and therefore fractures?

A

steroids

25
Q

How should you examine a joint?

A
  1. relevant joint and one joint below and above as pain may be referred from these joints
  2. look, feel move
26
Q

What are you looking for when examining a joint?

A
  1. erythema
  2. scars
  3. swelling
  4. muscle wasting
  5. bony deformities
  6. compare left with right
27
Q

What are you feeling for when examining a joint?

A
  1. effusion
  2. tenderness on the bones ligaments, tendons or along the joint line
  3. temperature
  4. neurovascular status
28
Q

How do you assess the movement of a joint?

A

full range of passive and active movement

29
Q

How are articular conditions more likely to present?

A
  1. diffusely inflamed joint (red, hot painful)

2. pain on passive and active motion

30
Q

How are peri-articular conditions likely to present?

A
  1. focal point of tenderness on palpitation

2. pain usually much worse on active than passive movement

31
Q

What do you look for on examination beyond the joint?

A
  1. Skin
  2. Nails
  3. Uveitis
  4. Mouth ulcers
  5. Lung signs suggestive of fibrosis
32
Q

What are the key things in the skin you are looking for?

A
  1. Tophi
  2. Rheumatoid nodules
  3. Rashes
33
Q

What are Tophi?

A

deposits of urate crystals

34
Q

Where can tophi be found?

A
  • anywhere on body around joints and bones

- can break through skin with a chalky appearance

35
Q

What do tophi suggest?

A

chronic gout

36
Q

What are rheumatoid nodules?

A

subcutaenous nodules

37
Q

Where are rheumatoid nodules found?

A

elbows and ears

38
Q

What do rheumatoid nodules suggest?

A

rheumatoid arthritis

39
Q

When are rashes seen?

A
  • condition that can also cause arthritis

- e.g. psorasis and SLE

40
Q

What are you looking for in the nails?

A
  1. pitting
  2. subingual hyperkeratoisus
  3. onycholysis
41
Q

What are these nails signs suggestive of?

A

psorasis, assoicated with psoratic arthritis

42
Q

What is uveitis?

A

inflammation of middle layer of eye

43
Q

How can you spot uveitis?

A
  1. painful red eye
  2. diminshed vision
  3. sometimes irregularly shaped pupil
44
Q

What is uveitis associated with?

A

HLA-B27 positive inflammatory arthropathies

45
Q

Why do you look for mouth ulcers?

A

IBD (Crohn’s) which is associated with arthropathy

46
Q

What are lung signs suggestive of fibrosis?

A

fine crackles at end of inspiration, clubbing

47
Q

Why are you checking for signs of pulmonary fibrosis?

A

associated with inflammatory arthropathies e.g. rheumatoid arthritis and their treatments (methotrexate)

48
Q

If diagnosis is unclear what must you perform and why?

A

arthrocentesis to exclude septic arthritis

49
Q

What test do you perform on the aspirate?

A
  1. microscopy (cell count and crystals)
  2. gram stain
  3. culture (takes at lest 24 hr)
50
Q

What 4 things are you looking for on the aspirate?

A
  1. crystals
  2. infection
  3. blood
  4. white cells

Z Year3 Clinical Presentations (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions